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PubMed1998

Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study.

BACKGROUND/AIMS: International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared. METHODS: In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity. RESULTS: Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p < 0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p > 0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p < 0.001). CONCLUSION: Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons' willingness to operate, and patient demand.

Aged↗

PubMed2003

Trends in incidence and case fatality rates of acute myocardial infarction in Denmark and Sweden.

OBJECTIVE: To compare the incidence and case fatality of acute myocardial infarction in Denmark and Sweden. DESIGN: A cohort study, linking the national registries of hospital admissions and causes of death in the two countries. PATIENTS: All admissions and deaths with acute myocardial infarction as primary or secondary diagnosis were extracted (Denmark, 1978 to 1998; Sweden, 1987 to 1999). MAIN OUTCOME MEASURES: The incidence was estimated using the first acute myocardial infarct for each patient. Case fatality was estimated in the first 28 days after acute myocardial infarction, including prehospital deaths. All rates were adjusted for age. RESULTS: The incidence of myocardial infarction and the case fatality declined significantly among all subgroups of patients. Case fatality was higher in Denmark early in the study period (1987-1990) than in Sweden. The odds ratios (OR) ranged from 1.28 to 1.50 in the four age groups. In 1994-1999, the prognosis of patients younger than 75 years did not differ. Patients aged 75-94 years still fared worse in Denmark (OR 1.21, 95% confidence interval 1.17 to 1.27). Women aged 30-54 years had a worse prognosis than men in both Denmark and Sweden (OR associated with male sex 0.85 and 0.90, respectively). In contrast, for patients older than 65 years, women had a better prognosis than men. This difference in the effect of sex with age was significant (p < 0.0001) and did not change over time. CONCLUSIONS: Case fatality after acute myocardial infarction was notably higher in Denmark than in Sweden in 1987-1991, but in the later periods the prognosis was comparable in the two countries.

Adult↗

PubMed1999

Do morphology and stage explain the inferior lung cancer survival in Denmark?

Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.

Aged↗

PubMed1985

Cohort trends in incidence of cervical cancer in Denmark in relation to gonorrheal infection.

In England & Wales and in Scotland an association has been found between the cohort pattern in mortality for cervical cancer and gonorrheal infection, used as indicator of sexually transmitted diseases in general. An equivalent association could not be found in the United States. In Denmark a peak in gonorrheal infection was observed towards the end of World War II. The maximum level attained in Denmark was higher than reported from the other countries; in Copenhagen the attack rate was 3.3 times the rate for the rest of Denmark. Incidence data on cervical cancer in Denmark are available from 1943 to 1977. The 1918-27 birth cohort is assumed to be the one most heavily affected by the gonorrhea epidemic during the war. Incidence data accumulated over a broad age span show no general excess risk of cervical cancer for women born 1918-27, but the incidence is increased for this cohort 15-20 years after the gonorrheal infection. The cervical cancer rates are higher for women in Copenhagen than for all Danish women, but the excess risks for the affected cohorts are less systematic here. The limited size of the population in Copenhagen, migrations, and an intensive screening are possible explanations for the divergence between the results for all of Denmark and for Copenhagen. The study indicates an association in Denmark between sexually transmitted diseases and cervical cancer, and the study shows the importance of taking the risk-modifying effect of screening into account in studies of etiology for cervical cancer.

Adolescent↗

PubMed1996

Potentially avoidable perinatal deaths in Denmark and Sweden 1991.

BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. RESULTS: Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) was significantly higher in Denmark than in Sweden. CONCLUSION: Application of the Nordic-Baltic Perinatal Death Classification on perinatal deaths in Denmark and Sweden in 1991 raises the questions as to why the rate of perinatal death of malformed infants is higher in Denmark than in Sweden and whether intrapartum care in Denmark could be improved.

Cause of Death↗

PubMed1991

Resources and productivity in radiation oncology in Denmark, Finland, Iceland, Norway and Sweden during 1987.

Data concerning megavoltage equipment and use of megavoltage external beams in cancer management during 1987 in Denmark, Finland, Iceland, Norway, and Sweden were collected from all 37 centres serving a population of 23 million in these countries. Population per Linear Accelerator Equivalent (LAE) unit ranged from 0.30 million/LAE unit (Denmark) to 0.19 million/LAE unit (Sweden). The number of field treatments were 227,548 (Denmark), 259,917 (Finland), 10,426 (Iceland), 147,960 (Norway) and 490,126 (Sweden). The number of field treatments per million population per year ranged from 35,229 (Norway) to 58,438 (Sweden). The number of field treatments per LAE unit/year ranged from 13,192 (Denmark) to 9,546 (Norway). The fraction of cancer patients receiving megavoltage radiotherapy in 1987 out of all newly diagnosed cancer patients during 1987 was 24% in Denmark, 37% in Iceland, 25% in Norway, and 34% in Finland and Sweden. We conclude that Denmark and Norway probably did not provide adequate levels of radiotherapy for their cancer patients during 1987.

Denmark↗

PubMed1992

Sudden infant death syndrome (SIDS) in Denmark: evaluation of the increasing incidence of registered SIDS in the period 1972 to 1983 and results of a prospective study in 1987 through 1988.

To investigate a reported increase, from 0.4 to 1.3 per thousand live births, in the Danish incidence of sudden infant death syndrome (SIDS), a retrospective analysis of SIDS in Denmark from 1972 to 1983 was carried out. Based on data registered with the National Board of Health, a notable regional difference in SIDS rate between the western and eastern parts of Denmark was found. This difference did not correlate with the overall postneonatal mortality by region. Danish law requires medicolegal investigation in all cases of sudden unexpected death. Medicolegal autopsies are performed only in the three forensic institutes which cover all of Denmark. Despite the law and a uniform organization of the forensic medical services, differing application of postmortem examinations and individual interpretation of the history and autopsy in cases of sudden infant death existed. Differences in reporting of respiratory infections, suffocation, and cardiac malformation were found to contribute to the increase and to regional disparities in SIDS incidence. The three Danish forensic institutes examined all cases of sudden infant deaths in Denmark 1987 and 1988. These cases were classified as explained cause of death, pure SIDS, and atypical SIDS; atypical cases were evaluated by consensus. The SIDS incidence (the number of classic SIDS and atypical SIDS per thousand live births) was 1.9 in 1987 and 1.3 in 1988, and it was identical in the eastern and western part of Denmark; however, a higher incidence both of overall postneonatal and SIDS mortality was found in the middle region of Denmark.(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy↗

PubMed1997

Public health and pork and pork products: regional perspectives of Denmark.

An ambitious programme to eliminate pork as an important source of human salmonellosis was initiated in Denmark in 1993 by the Ministry of Food, Agriculture and Fisheries. The programme comprises control of feedmills, breeding and multiplying herds, slaughter herds and slaughter plants, as well as the final product, fresh pork. As a consequence, the level of occurrence of Salmonella spp. in fresh pork produced in Denmark is approximately 1%. Yersinia enterocolitica 0:3 infections are common in slaughter pig herds in Denmark, and pork is considered to be the only source of human infection in the country. The incidence of pork-related occurrences of human salmonellosis and yersiniosis in 1996 was approximately nine cases per 100,000 inhabitants for both diseases. All swine in Denmark are screened for Trichinella spp. infection, although no positive results have been obtained since 1930. Swine are not considered to be a source for Campylobacter jejuni or enterohaemorrhagic Escherichia coli in Denmark. Listeria monocytogenes can be detected in relatively high rates in pork: however, the incidence of human listeriosis is only 0.5 cases per 100,000 inhabitants. Toxoplasma gondii antibodies have been demonstrated in 3% of slaughter pigs, though the importance of pork as a source of infection is probably very low. Denmark is officially free from Brucella abortus, B. melitensis and Mycobacterium bovis.

Abattoirs↗

PubMed1988

Antibiotic therapy of meningitis caused by ampicillin-resistant Haemophilus influenzae in Denmark and Greenland 1981 to 1987.

A survey was performed in Denmark and Greenland in order to determine whether the current recommendation of ampicillin (400 mg/kg/day) for initial treatment of purulent meningitis is appropriate. Data obtained 1981-1987 in an ongoing nationwide programme for surveillance of ampicillin-resistant Haemophilus species was analysed, and patient records of 21 cases of meningitis caused by ampicillin-resistant Haemophilus influenzae strains (17 in Denmark, 4 in Greenland) reported in the period 1981-1987 were reviewed. In Denmark the overall rate of ampicillin-resistant Haemophilus influenzae was estimated to be approximately 2% for the study period, and the average rate of resistant isolates from spinal fluid was 5.2% (range 0-12.3%). The incidence of meningitis caused by ampicillin-resistant Haemophilus influenzae strains remained low in the Danish population (around 0.05/100,000/year) except for a peak in 1985. The overall mortality rate of Haemophilus influenzae meningitis for the study period was 2.4%, which was the same as before 1980. In Greenland the actual number of cases of meningitis caused by ampicillin-resistant Haemophilus influenzae was small, but the incidence was at least 40 to 80 times higher than in Denmark with a high mortality rate (50%). These observations prompted revision of the antibiotic regimen in Greenland, whereas the regimen was considered appropriate in Denmark.

Adult↗

PubMed2000

Screening for infection of Trichinella in red fox (Vulpes vulpes) in Denmark.

A total of 6141 foxes (Vulpes vulpes) were examined for infection with Trichinella. The foxes were killed in Denmark during the hunting season 1995-1996 and 1997-1998; 3133 and 3008, respectively. Foxes included in the investigation came from throughout the country with the exception of the island of Bornholm. The right foreleg from each fox was submitted for investigation. The legs were stored at -20 degrees C for 3-10 months prior to examination. Following thawing, muscle tissue (10 g) from each leg was examined by trichinoscopy and by a pepsin-HCl digestion technique. In 1995-1996, three foxes were found positive corresponding to a prevalence of 0.001. Each of the infected foxes harboured an extremely low infection, i.e. about one larva per 10 g muscle tissue. It was not possible to obtain sufficient larval material for species identification. All three foxes were shot in the vicinity of a small village in the north-western part of Denmark. In 1997-1998 no Trichinella cases were found. The results, compared with previous studies, indicate that the prevalence of infection of Trichinella sp. among wild living foxes in Denmark is very low. This is further supported by the fact, that no infection of Trichinella sp. has been found in slaughtered pigs in Denmark for more than 65 years, which suggests that the infection pressure is very low. Considering the facts above we conclude that the risk of Trichinella infections is negligible in intensive indoor pig production units in Denmark whereas high local prevalence of Trichinella infections in the wildlife might constitute a serious risk for the expanding outdoor pig production.

Animals↗

PubMed1998

Trends in the resistance to antimicrobial agents of Streptococcus suis isolates from Denmark and Sweden.

This study was conducted to determine the MIC values of historical and contemporary Streptoccocus suis (serotypes 2 and 7) from Denmark and S. suis (serotype 2) from Sweden. A total of 52 isolates originating from 1967 through 1981 and 156 isolates from 1992 through 1997 in Denmark and 13 isolates from Sweden were examined for their MICs against 20 different antimicrobial agents. Most antimicrobials were active against most isolates. A frequent occurrence of resistance to sulphamethoxazole was observed, with most resistance among historic isolates of serotype 7 and least resistance among isolates from Sweden. A large number of the isolates was resistant to macrolides. However, all historic serotype 2 isolates from Denmark were susceptible, whereas 20.4% of the contemporary isolates were resistant. Among serotype 7 isolates 23.3% of the historic isolates were resistant to macrolides, whereas resistance was found in 44.8% of the contemporary isolates. All isolates from Sweden were susceptible to macrolides. Time-associated frequency of resistance to tetracycline was also found. Only a single historic isolate of serotype 2 was resistant to tetracycline, whereas 43.9% of the contemporary serotype 2 isolates and 15.5% of the contemporary serotype 7 isolates were resistant. Only one (7.7%) of the isolates from Sweden was resistant. The differences in resistance between historic and contemporary isolates from Denmark were statistically significant. This study demonstrated a significant serotype-associated difference in the susceptibility to macrolides and tetracycline and demonstrated that an increase in resistance among S. suis isolates has taken place during the last 15 years to the two most commonly used antimicrobial agents (tylosin and tetracycline) in pig production in Denmark.

Animals↗

PubMed2003

Narcotics at street level in Denmark. A prospective investigation from 1995 to 2000.

This article describes an investigation of illicit drugs at street level in six selected police districts in different regions of Denmark. The investigation was carried out during a 6-year period from 1995 to 2000. During the period, a total of 1244 samples were examined, as about 200 samples were seized each year. A total of 94% of the seized samples were familiar drugs: heroin base, heroin hydrochloride, cocaine hydrochloride and amphetamine sulphate. Only 2% of the samples contained designer drugs. From having constituted 53% of the samples in 1995, the frequency of heroin base fell during the period to 27% of the samples in 2000. The frequency of heroin hydrochloride was unchanged. In the same period, the frequency of cocaine hydrochloride increased from 10% of the samples in 1995 to about 25% of the samples in 2000. Apart from a few exceptions, cocaine had the same extension in all regions of Denmark after 1996. Amphetamine was more frequent in the west of Denmark, while heroin hydrochloride was more frequent in central Denmark. The purity of heroin base was lower in the period 1997-1999 than in the other years. During the entire period, the purity of cocaine hydrochloride and amphetamine sulphate fell, while the purity of heroin hydrochloride was unchanged. No significant differences between the various regions of Denmark were detected during the period in the purity of heroin hydrochloride, heroin base, cocaine hydrochloride or amphetamine sulphate. MDMA was the most frequent designer drug, but other types of designer drugs such as MDA and MDE and the less common PMA, PMMA and MBDB were also found.

Amphetamine↗

PubMed2000

Cervical cancer screening in Denmark.

Denmark is divided into 15 counties and it is up to regional politicians and the health authority in each county to organise the cervical screening programmes. The National Board of Health issued national guidelines and recommendations for the cervical cancer screening back in 1986, and these guidelines are now, in 1998, almost fully implemented. In this study, a literature review on cervical cancer screening in Denmark, review of local guidelines, personal interviews with pathologists and collection of information about the education of cytotechnologists in Denmark was carried out. In Denmark in 1997 90% of women aged 23-59 years and 46% of women aged 60-74 years were covered by organised screening. A total of 650000 smears were taken annually. This figure corresponds to screening of all Danish women aged 25-59 years on average, every second year. The national recommendation is screening every third year. Thus, as the incidence of cervical cancer in Denmark is decreasing, we could probably move towards a longer screening interval. However, before the Danish recommendations are changed, more detailed data on the actual performances of screening programmes are warranted.

Adult↗

PubMed2002

Genetic diversity and the phylogeography of parthenogenesis: comparing bisexual and thelytokous populations of Nemasoma varicorne (Diplopoda: Nemasomatidae) in Denmark.

The millipede, Nemasoma varicorne, represents a textbook example of geographic parthenogenesis with thelytokous populations being distributed north, east, south and west of the distribution of the bisexual ancestor in the deciduous forests of central Europe. We here describe variation in amplified fragment length polymorphisms (AFLP's) in sympatric bisexual and thelytokous populations of N. varicorne in Denmark and compare the relationships of Danish populations with animals from The Czech Republic, England and Poland. Thelytokes from Denmark, England and Poland form a monophyletic cluster that differs from bisexuals from Denmark and Czechia for about 30% of the fragments. A single clone is widely spread over Denmark (34 of 38 localities), with rare clones being detected at four other localities. The phylogenetic pattern implies strongly that thelytoky evolved prior to the post-glacial colonization of northern Europe. This further suggests that the two forms have interacted extensively during this colonization and that the thelytokes have been excluded from older forests by competition with the bisexual forms. Our results further suggest that the success of the thelytokous form, at least in Denmark, is not due to abundant clonal diversity as hypothesized by the frozen niche variation model.

Animals↗

PubMed2003

A nationwide study of continuous subcutaneous insulin infusion (CSII) in Denmark.

AIMS: To record the number of patients treated with continuous subcutaneous insulin infusion (CSII), the attitude to CSII treatment among diabetes care providers and the characteristics of pump users in Denmark. METHODS: A questionnaire was mailed to all departments of endocrinology, internal medicine and paediatrics in Denmark (n = 73) to determine the number of diabetic patients treated with CSII and the attitudes of chief consultants to it. All patients using CSII were identified and data from their records collected. RESULTS: Primarily Type 1 diabetic patients (n = 142) were treated with CSII, approx. 0.5% of patients in Denmark. The explanations given for this low frequency varied for non-CSII and CSII-using diabetologists. Both found lack of funding important. In addition, the non-CSII-using group had a perception that CSII was dangerous. The CSII-using diabetologists found that no more patients were interested and that it did not significantly improve metabolic control. The mean age of pump users was 48.1 +/- 10.5 years and the mean time wearing a pump 14.1 +/- 6.3 years. Mean HbA1c was 7.9 +/- 1.2% during CSII, with a significant difference among the 15 centres (P < 0.05) and a tendency to be lower in females (P = 0.07). CONCLUSIONS: CSII is infrequently used in Denmark despite pump users showing reasonably good metabolic control. The most common explanations for these low figures are lack of expertise and funding for CSII. If more patients in Denmark were to be offered pumps, education of healthcare providers would be needed and the funding would have to be clarified.

Denmark↗

PubMed2000

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors.

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15%, among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).

Aged↗

PubMed2002

Antibiotic prescribing in general practice: striking differences between Italy (Ravenna) and Denmark (Funen).

OBJECTIVE: To compare antibiotic prescribing in primary care in two European populations, one in Denmark (Funen), the other in Italy (Ravenna). METHODS: Reimbursement data (1999) were retrieved from the Odense Pharmacoepidemiologic Database (Denmark) and the Emilia Romagna Health Authority Database (Italy). The extent of antibiotic use (ATC J01) was analysed as the number of defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day), and as annual prevalence of use. A qualitative analysis was carried out according to the Drug Utilization 90% (DU90%) approach. RESULTS: Antibiotic consumption was 16.5 DDD/1000 inhabitants/day in Ravenna and 10.4 DDD/1000 inhabitants/day in Funen; the annual prevalence of use was 40 and 30 subjects/100 inhabitants, respectively. Italian children received a greater amount (four-fold in DDDs) of antibiotics than Danish ones, whereas consumption was only slightly higher in Italy than in Denmark in the other age groups. In Italy, injectable antibiotics (third generation cephalosporins or aminoglycosides) accounted for 4% of total DDDs and 11% of exposed subjects. In Funen, use of injectable antibiotics was negligible. The bulk of prescription (90% of total DDDs) was made up of eight (out of 38) different antibiotics in Denmark, mainly narrow-spectrum penicillins and macrolides (1st: phenoxymethylpenicillin), and of 18 (out of 74) antibiotics in Italy, mainly broad-spectrum penicillins, macrolides, fluoroquinolones and cephalosporins. CONCLUSIONS: These data show remarkable differences in antibiotic prescribing between Italy and Denmark, and suggest possible overuse and misuse of antibiotics in Italy.

Adolescent↗

PubMed1998

Epidemiology of respiratory syncytial virus infection requiring hospitalization in East Denmark.

BACKGROUND: Prophylaxis against infection caused by respiratory syncytial virus (RSV) with high titered RSV immunoglobulin or humanized antibody may soon be available in Europe. OBJECTIVE: To study the epidemiology of RSV infections requiring hospitalization in infants <6 months in East Denmark to provide a rational basis for decisions concerning prophylaxis against RSV. METHOD: Populat ion-based retrospective review of case records of infants <6 months admitted to pediatric departments with RSV infection in East Denmark from November 1, 1995, to April 30, 1996. RESULTS: Data were obtained from 459 infants. Seventy-three had predisposing conditions: prematurity, 49; pulmonary disease, 2; congenital heart disease, 7; neurologic disease, 6; others, 9. One preterm infant had bronchopulmonary dysplasia. The incidence of RSV infection requiring hospitalization in East Denmark among infants <6 months was estimated to be 34/1000/season. It was 32/1000/season among term infants and 66/ 1000/season among preterm infants (P<0.001). Infants with predisposing conditions and/or nosocomial infection (n = 24) had significantly more severe courses than otherwise healthy infants (P<0.01). One-hundred thirty infants received respiratory support by nasal continuous positive airway pressure, but only six required mechanical ventilation. No infants died. CONCLUSION: The course of RSV disease in East Denmark was milder than reported elsewhere, possibly as a result of the low prevalence of bronchopulmonary dysplasia in Denmark. However, RSV constitutes a considerable burden to the Danish pediatric health care system, and therefore prophylaxis against RSV is desirable.

Denmark↗